At a time when the health insurance industry is under government scrutiny, healthcare costs are skyrocketing, and consumers are becoming more aware of their patient rights, patients need to be vigilant about their medical bills. For those with medical insurance but who are facing inadequate coverage or insurance company loopholes, a medical insurance advocate provides valuable assistance recouping unwarranted expenses.

Adria Gross, founder of MedWise Insurance Advocacy based in Monroe, New York, has achieved life-changing results for her clients by working out highly beneficial arrangements for those who have exhausted all other avenues. Since founding her practice in January 2012, she has recovered approximately $500,000 in medical expenses that insurers have tried to block or that healthcare providers erroneously charged. This includes a recent case in which Gross - according to court documents - won a judgment over $43,000 for a New York man whose appeals had been denied ten times by his insurer since the summer of 2010. (Reference: Number CSB - 2012-824622)

Gross— a New York State-licensed insurance broker and consultant, and certified medical billing and medical claims expert—contacts all the appropriate state financial and legal agencies, Medicare/Medicaid, healthcare providers, and insurance companies to ensure patient rights are adhered to and that her clients get the rightful coverage for which they are paying. She stressed that diligence is often required and cases often go to the state insurance authorities for resolution.

“When people are sick or in recovery from an illness or surgery, the last thing they want to do is fight the insurance company or physician about their medical expenses; nor are they equipped to manage the intricacies of the health insurance industry,” said Gross. “As a medical insurance advocate, I am the liaison between patient or attorney, insurance company, and medical provider to work out a solution that resolves billing disputes.” In addition to working with individuals she handles cases for elder law and personal injury attorneys.

MedWise Turns Ten Denials into $43,000

After numerous attempts to get the proper reimbursement from his health insurance for services rendered two years ago, a New York resident turned to MedWise Insurance Advocacy for help. The patient hired MedWise after six denials of his medical claim by his medical insurance carrier. After several attempts to get the client the reimbursement he deserved, Gross filed his case (Number CSB - 2012-824622) with the New York State Department of Financial Services. The agency overturned the denials and instructed the insurance company to pay the money to the insured, Gross’ client.

Gross worked with Medicare and the patient’s secondary private health insurance carrier to ascertain actual medical costs and establish the denials.

She worked through three subsequent denials and then wrote to and appealed the case with New York State’s Department of Insurance, Department of Financial Services, Department of Consumer Affairs, and the state’s Attorney General.

She sent a copy of the letter to the health insurance carrier, who denied the claim a tenth time.

Through Gross’ repeated efforts, the NYS Department of Financial Services reversed the denial and the insurance company reimbursed her client $43,000—his original $35,000 out-of-pocket costs plus interest.

Gross’ case load is varied and she has helped clients work through medical claims and collect proper reimbursement from public and private insurance carriers, hospitals, healthcare providers, and nursing homes. She also provides key legislative contacts when requested.

Gross frequently speaks publicly to business and consumer groups about the current and upcoming health care laws, important insurance issues, and reminds insured individuals that they are entitled to the insurance coverage they are paying for—and they have recourse when insurers don’t want to pay for what is in the policy.

“Many people have claimed bankruptcy because the health insurance carriers do not want to pay claims,” said Gross. “My advice is to not give up and fight for the health insurance coverage you are legally covered for.”

As a nationwide medical insurance advocate, MedWise Insurance Advocacy in Monroe, New York supports individuals and their families, and elder law and personal injury attorneys on medical claim matters, from resolving medical bills and denied health insurance claims to handling medical lien claims and medical letters of appeal.

Founded by Adria Gross, a New York State-licensed insurance broker and consultant , and certified medical billing, coding and claims consultant, MedWise Insurance Advocacy is a division of MedWise Billing, Inc., a medical billing and credentialing practice. Gross uses her expertise in medical billing and coding, her knowledge of the prevailing rate structures of health care, and her expertise in Medicare and other health plans, to uncover discrepancies in diagnostic or procedure coding, or discover the loopholes through which insurance companies are attempting to deny a claim.

Her clients are primarily in New York, New Jersey, Connecticut, and Pennsylvania, but she can take cases anywhere in the United States.